Introduction to Clinical Psychology

Jeffrey Hecker, Geoffrey Thorpe

• Publisher: Psychology Press
• Year: 2015
• ISBN:
  9781317351160
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This introductory textbook gives students an appreciation of the field of clinical psychology as an applied science by teaching them the history and future of the field as well as ethical dilemmas facing psychologists today.

It is organized around four key themes:

• Science: the text analyzes and critiques research and practice in clinical psychology from a scientific perspective.

• Controversies: the text examines the conflict and controversies that continue to shape the discipline of Psychology.

• Currency: the text surveys the field of contemporary clinical psychology.

• Ethics: the text discusses ethical dilemmas faced by clinical psychologists in every chapter.

PART ONE
	Introduction and Foundations

CHAPTER
1	Definition and Training

Sop for a moment before reading any further. Take a minute to think about what you know, or think you know, about clinical psychology. On a piece of scrap paper (a 3×5 card or self-stick note will do), complete this sentence: “Clinical psychology is …”

Over the past several years the first author has used this exercise to begin his introduction to clinical psychology class. The responses he has gotten have been extremely interesting, ranging from the bluntly honest (“Clinical psychology is … I have absolutely no clue”) to the dramatic (“Clinical psychology is searching for clues, analyzing backgrounds, tying together leads, hopefully concluding with somewhat of an answer to the problem—a detective of the mind, if you will”). Organizing students’ responses to this incomplete sentence exercise into various categories has illuminated a picture of how clinical psychology is perceived by this sample of undergraduates. Far and away, most students associate clinical psychology with some type of therapeutic activity. Fully 79 percent of the responses identify clinical psychology as a field that is involved in psychological treatment. The most common type of response (44 percent), in fact, is to define clinical psychology in terms of therapy. The second most common type of response (35 percent) also emphasizes therapy but includes one or more other endeavors (e.g., research, assessment, diagnosis). A minority of students define clinical psychology as a research or scholarly discipline (10 percent).

Although the sample is neither randomly selected nor representative of undergraduate psychology majors throughout the country, my suspicion is that the identification of clinical psychology with psychotherapy is fairly common. As we will see later, in this chapter, this view of the field, while not inaccurate, does not capture the richness of the subject. There is so much more to clinical psychology.

Definition

Division 12, the Society of Clinical Psychology of the American Psychological Association, offers the following definition of clinical psychology. “The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels” (Society of Clinical Psychology, 2002). If your response to the incomplete sentence task approximated this definition, then maybe you don’t need this book. If it didn’t, read on.

We will not try to one-up the Society of Clinical Psychology by offering our own definition of the field. Rather, we will attempt to give you a sense of what clinical psychology is all about in four ways. First, we will describe some of the general characteristics of the discipline. Second, we will describe the professional activities and work settings of clinical psychologists. Third, we will seek to define clinical psychology by distinguishing it from related disciplines. Finally, in the second half of this chapter we will examine in some detail the training of clinical psychologists.

Characteristics of Clinical Psychology

Emphasis on Science

Clinical psychology is a subdiscipline of psychology. Many in the general public probably equate psychology with clinical psychology. It is the largest subdiscipline of psychology. The majority of doctoral degrees in psychology are awarded in clinical psychology (American Psychological Association, 1997, 1999) and clinical psychology is listed as the specialty area of the majority of the members of the American Psychological Association (American Psychological Association, 1997) and the majority of psychologists in the United States (Stapp, Tucker, & VandenBos, 1985)

We might be congratulated, sarcastically, for our keen grasp of the obvious when we point out clinical psychology’s relationship to the larger discipline of psychology. But we do so because recognition of clinical psychology as a specialty within psychology is important to have if one is to understand the discipline. Psychology is the branch of science that is devoted to studying and understanding behavior. As a subdiscipline of psychology, clinical psychology is imbued with the values and assumptions of science. A couple of the assumptions of science that are particularly important for understanding clinical psychology are determinism and empiricism. Determinism is the assumption that all events have causes and that these causes are potentially knowable. Science assumes that the causes of events are not random but follow some order or set of rules. These rules are also potentially discoverable. Events can be understood if we can identify all of the relevant rules. For psychology then, the causes of behavior are potentially knowable and are assumed to follow a set of rules that are also identifiable.

Empiricism is the assumption that science concerns itself with events that are observable and measurable. This is common sense. How can one study a phenomenon if the phenomenon cannot be observed? Historically, the argument that psychology should concern itself only with observable events is associated with behaviorism (see Chapter 3). John Watson launched behaviorism with a 1913 paper in which he argued that the only acceptable form of psychological data is observable behavior, thus excluding mental processes from psychology altogether. A strict empirical approach to science, however, is not tenable. Scientists have long recognized the need for nonobservables in science. Gravity is a phenomenon that cannot be directly observed but is extremely useful in understanding the action of objects of different mass.

Hypothetical constructs are not directly observable but are known by their relationship to observable events. Gravity is an example of a hypothetical construct. While we cannot observe gravity directly, the validity of statements about gravity can be tested through observation. Examples of hypothetical constructs in clinical psychology include anxiety, depression, self-efficacy, and intelligence. None of these constructs can be observed directly but predictions about observable behaviors (e.g., trembling, crying, approaching a feared situation, and performance on a test) can be made based upon these hypothetical constructs and these predictions are open to empirical test. Accepting that hypothetical constructs have a place in science does not mean the death of empiricism. The validity of a hypothetical construct can be tested by examining relationships among observable events.

In addition to the scientific assumptions that pervade clinical psychology, clinical psychology is a discipline that employs and values scientific methods. As such, there is a strong emphasis upon research in clinical psychology. Many but not all clinical psychologists do research. However, even those who do not are taught to value research and to apply knowledge gained through research to address practical problems.

Emphasis on Maladjustment

There are, of course, many subdisciplines of psychology besides clinical psychology. There are, for example, 52 other divisions of the American Psychological Association besides Division 12. Clinical psychology is a specialty within psychology that concerns itself with abnormal behavior and emotional suffering. For the most part, clinical psychology concerns itself with problems with which human beings struggle. As researchers, clinical psychologists apply scientific methods to understand how problems such as phobias, self-induced vomiting, compulsive gambling, and many others develop and are maintained. As clinicians, psychologists seek to understand the problems their clients experience and apply that understanding to help them gain relief. The focus upon “maladjustment, disability, and discomfort” is one of the characteristics that sets clinical psychology apart from other subdisciplines of psychology.

Emphasis on the Individual

Another characteristic that helps distinguish clinical psychology is its emphasis upon the individual. Psychology, as a science, seeks to understand the general relationships among variables that govern behavior. That is, psychology is interested in understanding behavior at a nomothetic level. Clinical psychology is interested in this level of understanding. However, the emphasis in clinical psychology is upon how general principles can be applied to understand the individual. This idiographic level of understanding is central to the practice of clinical psychology. An example may help illustrate the nomothetic-idiographic distinction. Research studies find that between 7 percent and 15 percent of women experience a period of significant depression after the giving birth and that acute life stressors are a risk factor for postpartum depression (Swendsen & Mazure, 2000). Clinical researchers have also found that the degree of social support and the range of coping strategies that a new mother has influence whether she becomes depressed and the severity of depression. This nomothetic information is used by the clinical psychologist to develop an idiographic understanding of the client referred for postpartum depression. What are the significant stressors faced by this woman? How does she cope? Who supports her? With the answers to these and other questions, the clinician develops an understanding of this particular woman’s experience of postpartum depression. Treatment is based upon this idiographic understanding.

Emphasis on Helping

A fourth characteristic of clinical psychology is that it is a helping profession. Clinical psychologists work to help people who are in psychological distress. If the findings or our informal study using the sentence completion task (“Clinical psychology is …”) are at all valid, you probably already associate clinical psychology with treatment. This association of clinical psychology with psychotherapy is interesting, given that psychotherapy was not really a significant function for clinical psychologists throughout the first half of the profession’s history (see Chapter 2).

None of the four characteristics of clinical psychology discussed—scientific assumptions and values, concern with psychological distress, emphasis on the individual, and helping profession—are unique to clinical psychology. Many disciplines within psychology apply a scientific approach to understand human behavior (e.g., personality, social, cognitive psychology). Other disciplines, most notably psychiatry, are concerned with human maladjustment. And there are, of course, many other helping professions (e.g., medicine, nursing, social work). It is the integration of these characteristics within a single discipline that distinguishes clinical psychology. Clinical psychology applies the assumptions and methods of psychological science to problems of human behavioral, emotional, and mental functioning to better understand and treat these problems.

Activities and Work Settings of Clinical
Psychologists

Another way of learning about what clinical psychology is involves looking at what clinical psychologists do. Clinical psychologists meet privately with people who are in psychological distress to help them overcome their problems. But clinical psychologists do so much more. They are involved in research, writing, teaching, assessment, consultation, administration, and other professional activities.

Research

Most clinical psychologists are products of graduate programs that include extensive training in research design, methods, and statistics. Clinical psychologists who train in traditional scientist-practitioner programs (see section on training) must conduct at least one piece of original research in order to obtain their degree. In fact, training in research is one of the characteristics that distinguishes clinical psychology from most other helping professions.

Although many clinical psychologists are involved in research in one form or another, a minority consider “researcher” to be their primary professional identity (Norcross, Karg, & Prochaska, 1997b). It is more typical for researcher to be one of the professional hats worn by a clinical psychologist. In fact, even clinical psychologists who are university professors report that, on average, they spend about a quarter of their professional time engaged in research (Norcross et al., 1997b).

The types of research clinical psychologists conduct is extremely varied. A quick perusal of the table of contents of a recent volume of the Journal of Consulting and Clinical Psychology received at the time of this writing show studies on adolescent physical aggression (Andrews, Foster, Capaldi, & Hops, 2000), work adjustment of bipolar patients (Hammen, Gitlin, & Altshuler, 2000), treatment of spit tobacco users (Hatsukami, Grillo, Boyle, Allen, Jensen, Bliss, & Brown, 2000), posttraumatic stress disorder (Schnurr, Ford, Friedman, Green, Dain, & Sengupta, 2000), prevention of delinquent and violent behavior (Stoolmiller, Eddy, & Reid, 2000), couples therapy (Jacobson, Christensen, Prince, Cordova, & Eldridge, 2000), and telephone-administered treatment of depressive symptoms in people with multiple sclerosis (Mohr, Likosky, Bertagnolli, Goodkin, Van Der Wende, Dwyer, & Dick, 2000).

Survey studies of clinical psychologists tend to find that a minority of psychologists publish the lion’s share of research. In fact, over twenty years’ worth of survey studies have repeatedly found that the modal number of publications for clinical psychologists is 0 (Norcross et al., 1997b). But this number is misleading. These same survey studies tend to find that most psychologists do publish at least one article (81 percent in the most recent survey; Norcross et al., 1997b). About three-quarters of clinical psychologists report having presented at least one paper at a conference and about one-quarter have published at least one book (Norcross et al., 1997b).

Teaching

Clinical psychologists are engaged in a variety of forms of teaching. About 50 percent of clinical psychologists report that they spend some portion of their professional time teaching (Norcross et al., 1997b). Between 15 and 20 percent are employed as professors at colleges, universities, and other academic institutions (American Psychological Association, 1999; Norcross, Karg, & Prochaska, 1997a). Clinical psychology professors typically teach courses that are within the domain of clinical psychology. At the undergraduate level, courses might include abnormal psychology, tests and measurement, introduction to clinical psychology, and systems of psychotherapy. Graduate courses taught by clinical psychologists include psychological assessment, theories of psychopathology, psychotherapy, clinical research methods, professional ethics, and any number of focused advanced seminars such forensic psych...

Table of contents

• Cover
• Title Page
• Dedication
• Table of Contents
• Preface
• Part One Introduction and Foundations
• Part Two Psychological Assessment
• Part Three Intervention
• Part Four Specializations in Clinical Psychology
• Appendix A: American Psychological Association’s Ethical Principles and Code of Conduct
• Appendix B: A Review of Statistical and Psychometric Concepts
• References
• Index